Appendix Surgery

Overview

Q. What Is Appendix ?

The appendix is a small, finger-shaped pouch of intestinal tissue extending from the cecum, which is the first part of the large intestine. The appendix is located in the lower right portion of the abdomen, it has no known function. Removal of the appendix appears to cause no change in digestive function.Blockage of the opening of the appendix into the bowel by a hard small stool fragment (fecalith) is believed to be a frequent cause of appendicitis.

The infected appendix must be surgically removed (emergency appendectomy), because if it becomes perforated (leaks), this can lead to infection of the entire abdominal space (peritonitis), which can be fatal.

Q. What Is Appendictis ?

Appendicitis is an inflammation of the appendix. Once it starts, there is no effective medical therapy, so appendicitis is considered a medical emergency. When treated promptly, most patients recover without difficulty. If treatment is delayed the appendix can burst, causing infection and even death. Appendicitis is the most common acute surgical emergency of the abdomen.

Diagnosis

Clinical diagnosis : - appendicitis remains a clinical diagnosis primarily. There is no set of invariably ocurring signs and symptoms. The two most common are anorexia (loss of appetite) and pain, although there are many cases of appendicitis that have neither of these. Other signs and symptoms included pain around the umbilicus that "moves" to the right lower quadrant, fever, nausea, vomiting, diarrhea, rigid and board-like abdomen, and worsening pain on walking. Appendicitis is most difficult to clinically diagnose in the very young and very old and in patients who are diabetic or on steroids.

Radiographic diagnosis : - - there are three radiographic studies that are commonly used to help diagnose appendicits, although in clear-cut clinical cases none is absolutely required. The most widely used is computed tomography (CT) of the abdomen and pelvis with 5 mm cuts. For best results this should be performed with intravenous dye, dye given by mouth (or PO), and dye given per rectum (although this is often not done as it is uncomfortable for the patient and radiology technician both.) Findings consistent with appendicitis are stranding in the mesentery, non-visualization of the appendix lumen, fluid in the pelvis, and an enlarged and thickened appendix, especially if it is seen in cross-section.

It must be noted that a normal CT does not rule appendicitis. Studies have shown that a CT can miss appendicitis, especially in the early stages, in up to 10% of cases.

Although less widely used today, plain-film radiography (aka "a flat plate") can be helpful in showing an opacity in the right lower quadrant that could be suggestive of an fecolith (insissipated stool in the mouth of the appendix).

The third radiology test that is sometimes used in children is an ultrasound of the right lower abdomen. This test is easy to perform, non-invasive, and has no radiation exposure, but it is of limited help as it is sometimes difficult to visualize the appendix (either normal or inflamed). It is almost never used in adults due to the larger body habitus.

Treatment

Laparoscopic Appendectomy is a much less invasive procedure for patients who have been diagnosed with an acute appendicitis than is traditional surgery.

The surgery can be completed in less than an hour in most cases.
The appendix is a small, finger-shaped pouch that projects out from your colon on the right-hand side. The appendix has no known purpose. Every year about 7 percent of Americans develop appendicitis - a condition in which the appendix becomes inflamed and filled with pus.

The main symptom of appendicitis is pain that begins around the navel and then shifts to the lower-right abdomen. The pain usually increases over a period of 12 to 24 hours, and eventually may be very severe.
Anyone can develop appendicitis, but it most often strikes people between the ages of 10 and 30 and is one of the most common reasons for emergency abdominal surgery in children.

The standard treatment for appendicitis is surgical removal of the appendix (appendectomy). In many cases the surgery is straightforward and you recover quickly. But if your appendix has ruptured, the surgery may be more complicated and you'll take longer to heal. A ruptured appendix that's not promptly treated can lead to serious complications such as an infection of the abdominal lining (peritonitis) or a walled-off area of infection (an abscess). In rare instances a ruptured appendix may be fatal.

Laparoscopic Appendectomy

The procedure is done under general anesthesia. Usually, we operate through 3 small incisions (each 0.5 to 1 cm) while watching an enlarged image of the patient's internal organs on a television monitor. After division of the blood supply to the appendix, its transsection, and closure of the appendiceal base, infected appendix is removed using a special protective bag from one of the incisions. A drain may be placed during the procedure. This will be removed before you leave the hospital.

Results may vary depending upon intraoperative findings and the patient's overall condition, but overall laparoscopic appendectomy offers at least several advantages over traditional open operation:

Less postoperative pain

Shorter hospital stay

Less postoperative infections

Faster resume of normal physical activities

Better cosmetic results

Symptoms

The first sign is usually a pain or discomfort in the centre of the abdomen. The pain usually begins near the umbilicus and moves down and to the right. This pain comes and goes in waves and increases on movement.

Pain is often thought at first to be a simple stomach upset.

nausea

vomiting

constipation

diarrhoea

inability to pass gas

low fever that begins after other symptoms

abdominal swelling

anorexia

Complications

Superficial wound infection - this is a risk with all surgical incisions and is increased if the skin edges are closed in the setting of late appendicitis or rupture.

Intraperitoneal abscess - this is fortunately unusual but can complicate up to 10% of cases of ruptured appendicitis.

Other - as with all surgeries there is always a risk of blood clots, pulmonary embolism, stroke, heart attack, and death.

In most cases, the specific reason for the inflammation is not known but it is due to blocking of the opening connecting the large intestine and appendix. In many cases it is caused by small pieces of hardened stool (faecaliths) that get stuck in the appendix.

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